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Wiki Assist Surg C Delivery
- Thread starter Partha
- Start date
Lisa Bledsoe
True Blue
The assistant should code 59514-80 because he/she is only participating in the C/S.
kbarron
Guest
I do not use the 80 on 59514 as it is for delivery only.
Lisa Bledsoe
True Blue
Karen - how would you justify coding for the complete delivery (only) when it is a surgical assist?
kbarron
Guest
The 59510 is for routine care and 59514 is delivery only. This is my understanding if the CPT code.
Lisa Bledsoe
True Blue
Right - so Dr. A would bill 59510 for global (including primary surgeon for the C/S) and Dr. B would bill 59514-80 for assisting on the C/S only.
kbarron
Guest
yes, 80 would be on that...sorry about that mentalpause!
Lisa Bledsoe
True Blue
We all suffer from that!
RebeccaWoodward*
True Blue
Patient delivers baby by C-Section. Both of the providers (Dr. A and Dr. B) in the practice provide antepartum care. I know that if one of the providers (Dr. B) provided *no* antepartum care, he can report CPT code 59514, Cesarean delivery only, to identify the assistant services w/ mod 80 if he did *not* provide any antepartum care. (Per CPT Assistant Oct 96). However, BOTH providers provided anterpartum care. If I take CPT Assistant 96 literally, Dr. B can not charge for 59514 since he provided antepartum care. CPT code 59510 does not allow an assist. How are you reporting the assistant MD if he has provided antepartum care?
kbarron
Guest
The md who had the most visits gets credit for antepartum..., this is how we do it here, if a different md from the practice. however, I would not bill this out as the providers are in the same practice. I would wonder why you would use 80 on 59514..Isn't this for delivery only? and 59510 for total global package....Some ins companies have different rules for OB...Check with your carrier.
RebeccaWoodward*
True Blue
All the literature I have found supports modifier 80 when there is an MD assistant for the c-section.
CPT Assist:
If the physician assists in the delivery but does not provide any of the antepartum or postpartum services, it would be inappropriate to use the 59510 code. Instead, use 59514, Cesarean delivery only, to identify the assistant services. Include 80 modifier to denote the assistant services provided.
So...If the assistant provides antepartum care, are you still reporting 59514-80? It seems to go against the guidance of CPT Assistant.
CPT Assist:
If the physician assists in the delivery but does not provide any of the antepartum or postpartum services, it would be inappropriate to use the 59510 code. Instead, use 59514, Cesarean delivery only, to identify the assistant services. Include 80 modifier to denote the assistant services provided.
So...If the assistant provides antepartum care, are you still reporting 59514-80? It seems to go against the guidance of CPT Assistant.
kbarron
Guest
Would you use 59515? C-delivery and post partum care..
59510 is exclusively for Primary surgeon. No appendation since it includes global AN & PN care.
While the 59515 is a code segregated for the primary surgeon who missed the global AN care( meaning it is not exclusively global).
So Dr. B can append to 59515, if she happens to assist the primary surgeon and provide the full PN care as well, to the patient , appending –mod 80. with the supporting documentation.
If Dr. B gives only assistance in CS , then she can bill with 59514-80
For the AN part of global , it is not likely to claim global AN by two providers from the same group at the same session or period of time. But when transfer occurs , Dr . B would be eligible for split , if she meets the requirements. Even then Dr. B cannot bill for 59510, when she happens to be an assistant only.
I hope this makes some sense
While the 59515 is a code segregated for the primary surgeon who missed the global AN care( meaning it is not exclusively global).
So Dr. B can append to 59515, if she happens to assist the primary surgeon and provide the full PN care as well, to the patient , appending –mod 80. with the supporting documentation.
If Dr. B gives only assistance in CS , then she can bill with 59514-80
For the AN part of global , it is not likely to claim global AN by two providers from the same group at the same session or period of time. But when transfer occurs , Dr . B would be eligible for split , if she meets the requirements. Even then Dr. B cannot bill for 59510, when she happens to be an assistant only.
I hope this makes some sense
RebeccaWoodward*
True Blue
Let me see if I understand you correctly...
Quote:
"So Dr. B can append to 59515, if she happens to assist the primary surgeon and provide the full PN care as well, to the patient , appending –mod 80. with the supporting documentation.
If Dr. B gives only assistance in CS , then she can bill with 59514-80
For the AN part of global , it is not likely to claim global AN by two providers from the same group at the same session or period of time. But when transfer occurs , Dr . B would be eligible for split , if she meets the requirements. Even then Dr. B cannot bill for 59510, when she happens to be an assistant only."
You're saying that the assistant can bill for 59515-80 IF he assumes full responsibility of the postpartum care; meaning transfer of care?
Both physicians work in the same group practice. In this case, this patient saw both physicians on different dates during the antepartum period. There will not be a transfer of care from Dr. A to Dr. B. In other words, the patient saw both physicians, different dates, during the antepartum care and will continue to see both provider's during the postpartum care; different dates.
Quote:
"So Dr. B can append to 59515, if she happens to assist the primary surgeon and provide the full PN care as well, to the patient , appending –mod 80. with the supporting documentation.
If Dr. B gives only assistance in CS , then she can bill with 59514-80
For the AN part of global , it is not likely to claim global AN by two providers from the same group at the same session or period of time. But when transfer occurs , Dr . B would be eligible for split , if she meets the requirements. Even then Dr. B cannot bill for 59510, when she happens to be an assistant only."
You're saying that the assistant can bill for 59515-80 IF he assumes full responsibility of the postpartum care; meaning transfer of care?
Both physicians work in the same group practice. In this case, this patient saw both physicians on different dates during the antepartum period. There will not be a transfer of care from Dr. A to Dr. B. In other words, the patient saw both physicians, different dates, during the antepartum care and will continue to see both provider's during the postpartum care; different dates.
There will not be a transfer of postpartum care from the Primary surgeon unless the Primary Surgeon (s)he happened to leave it to Dr. B for some reason which is not in practice. If does so, the Primary surgeon (s)he would have to go for a reduced service in her surgical procedure coding(with mod52). But whether the career allows this I doubt.
Dominic
New
Reporting For Assistant Surgeon
I just want to make sure I understand this clearly:
If the physician completing the cesarean section uses a 59510 then they are basically stating that they performed the procedure without an assistant surgeon?
I just want to make sure I understand this clearly:
If the physician completing the cesarean section uses a 59510 then they are basically stating that they performed the procedure without an assistant surgeon?